The goals of the proposed projects are to support my continued development and impact as a mentor, to establish a research training program for patient oriented research (POR) in the Section of Rheumatology at my institution, and to expand my current POR program. Regarding the former, I am strongly committed to devoting a significant percent of my career to mentoring. Among the trainees I am currently working with, I am the primary mentor for 2 junior faculty (1 who is a K awardee), 2 rheumatology fellows interested in pursing a career in POR, and 3 residents planning a career in rheumatology. While my primary interest is in the field of decision making, my training and previous practical experience in epidemiology allow me to be an effective mentor for trainees interested in other aspects of POR related to rheumatic disease. Given my commitment to mentoring, Yale's rich resources dedicated to POR, and strong institutional support to create this program, the K24 Award provides an invaluable opportunity to expand my mentoring efforts and to establish a specialized structured POR curriculum. The program will ensure that fellows interested in becoming independent investigators will be supported by an interdisciplinary team of mentors and will acquire training in clinical research methods and biostatistics. In addition, I will establish a biweekly Research in Progress meeting during which trainees and faculty will be expected to present materials at all stages of development and offer constructive critiques during each session. The training program will include formal mentoring sessions which will adhere to a process for moving research forward. The POR training program will also include formal evaluation of trainees and mentors. In addition to mentoring young investigators, one of my important long-term goals is to advance my own research agenda so that I can continue to conduct scientifically rigorous and meaningful POR. I have established a defined area of expertise and a strong network of collaborators with complementary proficiencies that will support and enhance my research program. Current examples include collaborations with Dr. Curtis (UAB) with whom I have recently submitted a grant to develop individualized outcome estimates in rheumatoid arthritis, Drs. Reyna (Cornell) and Peters (Ohio State) who are basic science experts in decision making and are current collaborators on a project to develop a decision aid in rheumatoid arthritis, Dr. Almazor (MD Anderson) with whom I am working on 2 projects examining the value of conjoint analysis in patients with knee OA, and Dr. Street (Baylor College of Medicine) an internationally renowned expert on communication, who is a collaborator on a new research project: Measuring Patients'Risk Perceptions in Real Time. New planned studies will continue to focus on understanding the reasons underlying poor quality decision making in clinical practice and I will expand my current projects to include randomized controlled trials to test the efficacy/effectiveness of the tools developed.